The origin and roles of the medical examiner
The origin of medical officers
Medical Officers role initially developed from the coroners in England during the 9th and the 10th centuries. The job of a coroner is an ancient post which dates approximately back in the eleventh century. By the beginning of the twelfth century, the office of the coroner was officially formalized by King Richard I, in the Erye Articles. This office had a local official who was responsible for the inquests for confirming the deceaseds identity, determining the manner and cause of death, collecting the death duties, confiscating property and investigating the treasure troves (OCME, 2010). Through the adoption of the British Common Law, the North America settlers came with the coroner laws and roles to early colonies. The early states constitutions would often place the position of the coroner, without defining its role. The first one was Georgia. The post was initiated shortly, after Norman Conquest of England in the year 1066. Initially, the work of a medical officer was done by public officials who used to be referred as crowers. The crowner together with several knights used to go out in an attempt to ensure that when somebody died, the king was informed, who in turn would in turn ask for the body of the person and perform the rituals they believed in on the dead body. The coroners office was first launched in England (and later the United States of American). The role offered a local county with an official whose core duty and responsibility was to protect crowns financial interest in any criminal proceedings. The position of the coroner was found useful by many other countries and thus, it was also established in America (OCME, 2010).
When Oklahoma was declared an independent state in the year 1907, their constitution was ratified, and the office of the corner was missing. The laws were thus revised in 1910 to recognize the position of a coroner through the Justice of Peace. Justice of the peace coroner system continued in Oklahoma until 1962. During this period of time, this part of justice was also conducted in the majority of the countries in an inefficient and haphazard manner. For example, inquests were mostly not held the very time violent death cases occurred. In many occasions, the undertaker just picked up the corpse, took it to a funeral home and then embalmed it. A doctor could be contacted afterward to sign out the death certificate using the information that he would be provided with. Efforts were made to transform the system but due to the ignorance and lack of interest on the importance of such changes, the attempts never bore any fruits. A number of consequential events occurred in mid 1950s which transformed the coroners office in the entire US forever (Sanchez, 2004).
The most contributing factor to the changes that were effected in the criminal deaths investigation was a woman from Oklahoma who had the habit of marrying and then poisoning husbands so as to take off the social security and the insurance benefits of the diseased estate. The case became too suspicious when she once poisoned a state highway department employee who had previously lost his first wife and children in Arkansas tornado. He then found the new wife through the lonely hearts club and moved in with her after two days and within two months he was also dead. Investigations showed that she had been poisoning her husbands with rat poison to benefit front their social security and insurance benefits. With the passing of the years and as the population of the entire US Increased, this case gained national popularity, necessitating a need for changes in the criminal murder investigations. Eventually, in 1961, a bill was effected and signed as law that begun the modern US medical examiner system. 1962, the medical examiner agency was formally launched. It was then called the board of unexplained deaths. It was only in recent years that the name was changed to the medical examiner description.
The first official acknowledgement for the medical examiners need through the training of the coroners was in 1860 a time when Maryland enacted a legislation that allowed the coroners to seek qualified physicians in an inquest, and in 1877, Massachusetts was the first state in US to substitute coroners with medical examiners by clearly differentiating and separating the duties, roles, responsibilities and authorities of both. A coroner was to work under the guidance of the medical officer as an assistant. However, for certain cases whereby the prosecuted was medical officer, the coroner was then expected to take the roles of the medical examiner for that particular situation only.
Practically, today, each of the territory, state and the Columbian district has an act which establishes the medical examiner or the coroner office and in some occasions both offices. The coroners office is a very ancient office which was established in the United States through the English Common Law Tradition. Initially an English coroner was the representative of the king who would be elected into the position or at times appointed by the king into the county. Originally, this coroner looked into many things over and above the suspicious death investigations. However, the duty and the roles of the coroner has evolved over the years and today greater development have been made to expand the effectiveness of the coroners by putting into place a more comprehensive and sophisticated office the Medical Examiner. On the other hand, coroners today need not be physicians or trained forensic pathologists---they are lay officials.
The office of the medical officer came from the Scottish and the European civil law practice of the inquest idea. The Scottish law system was very influential in the adoption of the medical examiner system in the whole of United States of America. In the year 1955, Texas legislature endorsed a statute which ruled out that the bigger counties ought to launch a medical examiners office and the medical examiner was required to be a qualified and trained physician. The other states in the US slowly followed the trends and the laws that had been set by these states Texas, Massachusetts, Georgia and Oklahoma. Eventually every state had a medical examiners office in its constitution which was well defined and separated from that of the district coroner. Today, the medical examiners office is well established and recognized in the autopsy and other related functions.
Definition of a medical examiner
A medical examiner is a public official who is charged with all the investigations of sudden, suspicious, mysterious and unnatural deaths in the region of his or her assigned jurisdiction. He is a physician trained in medicine and appointed by a county or a city to carry out autopsies on corpses of people believed to have died out of unnatural causes, in addition to investigating the circumstances and causes of such deaths. Medical examiners usually determine things such as positive corpse identification, the specific time of the death, whether death took place at the same place where the body was first found and the cause and manner of such deaths. In so doing they carry out autopsies and other medical tests which enable them to come up with accurate and precise details about these issues. A medical examiner is thus a doctor in possession of specific professional training in forensic pathology. Pathologists usually study diseases by examining the organs, tissues, body fluids as well as the cells. For the medical examiner, the examination usually occurs after the person has died.
There is a difference between a medical examiner and a coroner the work and duties of a medical examiner are more detailed as compared to those of a coroner although they operate in the same field. Therefore a medical examiner can be simply described as a doctor who has specialized training and skills in forensics whilst a coroner is an elected post that does not call for any medical background a coroner mostly subcontracts majority of the forensic duties and their roles and responsibilities are more of administration than medical. However, in most cases, a coroner is required to be in possession of at least a degree in law.
What should a medical examiner have
Medical examiners learn about cadavers in order to gain knowledge of diseases and to establish the cause of someones death. They are expected by law to have at least a Doctor of Medicine degree and a certificate in Pathology. This takes a total of eight years in learning the profession before on can start to practice. A degree in law is useful to many medical examiners especially those who regularly testify in court or who desire to work as professional witnesses in criminal trials in addition to civil trials. These requirements make the medical officers profession not only challenging but also competitive to achieve. The law imposed this law on the minimum qualifications for the medical examiners due to complains by the general public about the standard of investigations on the causes of suspicious deaths that were being conducted by the coroners coroners are not medical physicians and they work currently to assist he medical offices.
Responsibilities of the medical examiner in arriving at the criminal scenes
Traditionally, the importance of role performed by medical examiners the death investigation community and, coroners, has been seen as helping the criminal justice system. For the duration of the last number of decades, however, an imperative role for the three groups has arisen in public health. They have a critical role in epidemiologic research, the surveillance, and present public health activities and programs.
The role and responsibility of the of medical examiners in arriving at the crime sites has greatly evolved from a criminal justice service view to a larger involvement which now extensively benefits public safety, , public health and medical communities. It is predictable that public health responsibility of medical examiners may keep on growing and perhaps in the near future public health effect will outshine criminal justice as a chief focus of the medical legal death examination in United States.
The principal role of a medical examiner is to establish the cause of the death of a person whether by injury or disease. By law, they are supposed to determine the manner and cause of death which happens by accident, criminal violence, suicide, abruptly after a person was in good health, in prison, unattended by the practicing physician, in the police custody, by poison, by criminal abortion, disease that is threat to the general public health and injury or any toxin in workplace (Jordan, 1999). All the above cases must portray an element of suspicion making the deaths unnatural or mysterious. In instances where sudden death takes place but there is no evidence of possible mystery, the medical examiner will automatically decline the offer of investigating the deaths since it will be against his code of ethics and professionalism.
For the deaths which are as a result of accidents, the responsibility of the medical examiner at the scene is to examine whether the accident happened due to a natural cause or was planned with the intention of killing or permanently harming the victims. In criminal violence, medical officers use their skills and professionalism to come up with the concrete findings on the nature of the violence which resulted to death. In such cases, the aim is to establish the manner rather than the cause of death of the person. The most crucial cases in the establishment of death causes involve the cases of mysterious deaths of prisoners in the jails or in police custody, the abrupt death of a person who had been health and death due to poisoning. These three cases in most cases are spot highlighters of the element of criminal activity in the manner and causes of the deaths. It is for this reason that medical examiners are finding themselves in court rooms to testify on their findings although it is not an explicit part of their duty.
Medical examiners are usually tasked with the responsibility of establishing the cause of death but the American medical examiners are faced with an added role of establishing the manner of the deaths when arriving at the crime scenes. They thus determine the circumstances that led to the deceaseds path in demise. For example, if the diseased died as a result of drowning, did they willingly get into the water with stones in the pockets Which translates to suicide were they unwillingly held under water (Homicide) or did the deceased accidentally slip and were unable to swim out (accidental death) However in certain cases it becomes hard to determine the criminality in the action because the manner of death cannot be properly established. Such are the heroin overdose cases whereby the manner of death is usually unclear.
The essence of involving the services of a medical examiner is to ensure that the parties concerned with the diseased get to understand the ultimate cause of death of their deceased, after which legal suits may follow where evidence of death out of a criminal activity is provided alongside the parties involved. Criminal scenes are the places where either the death occurred or any proximal scenes that come as a result of the death under investigation. Medical examiners have one goal in the whole process of investigating and determining the causes and the manner of death to prove that there was an element of crime in the occasioning of the death and that under natural circumstances, the individual would still be alive. Unnatural deaths are here deemed to be the deaths that occur out of the ordinary. For example, the sudden death of a person after serious contentions with an enemy or a rival is likely to be unnatural and an act of vengeance from the rival. At the scene of crime in such a situation it is expected of the medical examiner to perform autopsy and other professional tests on the body of the deceased to establish whether the suspicion hold water or the death was just out of a natural cause.
At the crime site, the medical examiner is responsible for taking into possession such items as suicide writings and notes as well as portable objects. The importance of these items is not to perform the autopsy but to act as sources of evidence in the event that a law suit is involved or the family of the diseased protests against the results provided by the medical examiner as being the cause of death of their person. Mostly, protests happen when the cause of death is determined to be something embarrassing to the society or the family itself. In addition, the items such as the suicide notes or any indicative writings automatically eliminates the reason for involving a medical examiner unless those concerned with the death of the deceased want to be absolutely sure that the person really committed suicide or otherwise. The medical examiner also uses these items for records maintenance of all the deaths investigated. It is important that they maintain a record of all the investigated cases because these data are later used by the National Statistics Bureau for assessing both the level of criminal deaths as well as the effectiveness of the medical examiners in performing their roles in the society and specific appointed jurisdiction. Copies of the records concerning every death where there is a signal of criminality are sent from the medical examiners office to the relevant District Attorney as is required by the law.
Furthermore, in deaths with criminal implications, the medical examiners have the responsibility not only to the deceased but also to the community at large. The responsibility to the deceased entails establishing a true and valid course of the unnatural death which paves way for any consequential action against the offender, whilst the responsibility to the community at large is in ensuring that criminal deaths are reported and the possible legal action taken so that the security of the entire community is well guarded.
It is also the role of medical examiners to counter and avoid any form of phone notifications about deaths and criminal murders so that they do not get involved in the criminal activity while trying to solve the problem. This role was imposed after one incidence in Texas State where a medical examiner was notified about the death of a person over the phone. The person was a close acquaintance to the medical examiner and therefore he placed a top priority in investigating the cause of the death of the person. Little did he know that it was a set up by the local gang to stop the work of investigation he was doing in the jurisdiction. He was later found dead by the roadside and the case had also to be investigated. It became complex to identify the cause of death because the gang used his tools and phone to avoid any possible recognition from the murder site. They rely on the agreements with the police chaplains or the volunteer agencies to make death notifications.
In arriving at the crime scenes the medical examiner works most closely with the risk manager because this ensures that deaths which contain an element of criminality have been promptly presented to the medical examiners office for the autopsy tests and any other tests which may be necessary in determining the manner and cause of the criminal deaths. The risk manager gives the medical officer the absolute and accurate information at the site so as enable the latter to make appropriate decisions concerning the jurisdiction. Failure to give complete and accurate information makes the medical examiner to decline such jurisdiction on a death case that ought to have been examined. Although unintentional misrepresentation is not entirely a criminal offense, it causes delays in the examiners execution of the duties and this could mask or prevent accurate final judgment regarding the deaths.
Medical examiners also have forensic authority which is conferred on their role by the virtue of experience and training. The forensic authority allows the medical officer to decline from performing any tests on any dead body which is presented to them without sufficient litigation process that shows that the person died and no reasonable method could be used to determine the cause of their death apart from the use of the medical examiners services. The medical examiner is always at freedom to suggest that an autopsy be done on a death case in which, according to his reasoning and skills seems to be criminal. The law allows him to carry out such a test even against the will of the deceased family members, provided that it will serve the general good of the public at large (Randy, 2007).
In addition, the criminal death scenes also places on them some form of cultural authority because the family members of the deceased can only remain hopeful and believe that they are not biased and only rely on purely the information provided to them by their professional tests. Developments in the modern technology pose questions on the jurisdiction on the reliance of medical autopsy as well as organ removal in identifying the cause of death. This question automatically paces the accuracy and authority of the medical examiners in a serious threat.
Common misconceptions about the role of the medical examiner
In the course of their duty, the medical examiner have been mistaken a fact which jeopardizes their responsibility in the criminals deaths and murder investigations. There are three basic misconceptions about the purpose of medical examiner in the criminal murder analysis. To begin with, the medical examiner carries out autopsies which are meant for medical purposes such as research and education while at the same time for the hospital. This misconception misguides their role because the purpose of the tests performed on the dead bodies is meant for pure legal purposes. It is for this reason that the medical examiners are not employees of the private medical sector but are essentially the employees of the public health with is a governmentally controlled department. The second misconception about the medical officers regards the assumption by majority of the public that the medical examiner mutilates and disfigures the body. Medical officers are not only extremely professional besides being respectful, but are also skillful in the preservation and original appearance of the dead body. They ensure that all the organs of the body remain intact and in place at the time of burial.
The last misconception about the role of the medical examiner relates to their relationship with the coroners. To many people, a coroner is as good as the medical examiner. However, the responsibility of the medical examiner in arriving at the criminal scene goes far beyond the testing of the corpse and determining the reason as to why the death occurred in a non natural setting. Over and above this, the medical examiner carries the responsibility of reporting to the district attorney all the cases within the agreed duration of time that he or she has examined and proved the death to be as result of criminal death. The attorney relies on the information provided by the medical examiner to make recommendations and proposals to the states government on the methods that should be used to curb alarming criminal death rates. For example, in 1999, it was found out that many people had committed suicide due to depression and stress. The district attorney therefore collaborated with the county medical examiner to analyze the possible causes of these deaths and it was found out that the many of these people contemplated to suicide after failing to succeed in the millennium that was approaching, either financially or in career and thus they found it meaningless to crossover to a new millennium with the same fears and state of mind since the financiers has predicted that the economy was likely to experience even tougher economic times in the twenty first century than was in the twentieth century. Therefore it calls for the results of the medical examiner to be so accurate such that they can be used to draw up a general conclusion on the state of mind of the person committing suicide or intentionally getting themselves in extremely risky conditions.
The challenges faced by the medical examiners in arriving at the crime scene
In the process of executing their duties and responsibilities, medical examiners face many different challenges and managing these challenges becomes part of their responsibility in arriving at the crime scenes. The first and most challenge that they encounter involves the separation of their role from the medical duties. This is because although they are trained doctors in the field of pathology and forensic studies, their duty is based and accountability to the legal department. However, most people expect the medical examiner to not only determine the cause and manner of death, but also the responsibility of the practicing physician in preventing or cautioning on the risk of their patient in the case of a suspicious death from quick illness. In addition, the examiners are any times unable to determine the manner of death especially on the cases of suspicious deaths out of overdose. This is because it is difficult to tell the intention of the person who overdosed. At times, overdosing could be due to a suicidal intention or lack of understanding of prescription given by a physician. In such cases, the family members of the diseased do not get satisfied by the judgment made by the medical examiners which in some cases causes the examiner to be sued of inaccurate determination of deaths.
Furthermore, the medical examiners are faced by cultural limitations in performing autopsy on a body. Cultural problems are mostly present when handling cases that involve some families opposing autopsy on the basis of religious or cultural background. In other cultural challenges, the family members literally come to the medical examiners office prepared to carry out ceremonial washing of their dead and the medical examiners have found themselves allowing such families to go ahead, although the frequency and numbers in which they turn up is what becomes a challenge since they disrupt the daily routine of the professionals. However, this problem is not very common among the Americans but among the settlers and immigrants in the country.
In some of the death cases presented to them, the corpse could be burnt or damaged to an extent that any examination on it would not be able to produce accurate results or would mask the final determination of the cause of death. In such circumstances, it is upon the medical examiner to decline conducting tests on the body before the case is recorded as being under investigation because the results would become misrepresentative of the manner or cause of death. Once a case is recorded as being under investigation, there is a direct role tied to the medical examiner to complete the examination and deliver the results. Many, of the times the failure to properly determine causes of death is not blamed on the condition of the corpse or the remains but on the incompetence of the medical examiner.
Conclusion
In the current century, medical examiner offices are gradually replacing coroner systems. Although the medical examiner position is an evolution of the coroner system, the coroner is now seen as a less contributory factor in the field of investigations of criminal deaths. The roles and the responsibility played by the medical examiner are diverse since they cut across medicine and law. As a member of the public health, the medical examiner always aims at protecting the society assigned by the state or county constitution but eventually, medical examiners end in a thankless role nobody wants to come into contact with them because they all hope and wish that the deaths of the loved ones will ultimately come out to be natural and peaceful, reflecting a fulfilled lifetime. However, the role of the medical examiner will most often than not rule out that certain mysterious, malicious and personal reason caused the deaths. The medical officer role will give answers to questions like how, when and where but never will they explain to us the why which everybody would want to be the first question answered. Medical examiners have experienced difficulties in arriving at the conclusion of the cause and manner of death because many people tend to doubt based on either religious or cultural difficulties. In overcoming these difficulties and making their intention and purpose in the society more clear, the responsibility of the medical examiner continues to widen and probably, a more advanced individual will be required to work with the medical officer since criminal death rates are seriously escalating not only in the United States of America but in the world at large.
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